<script src="<?php echo get_url('js/jquery.validate.js')?>" type="text/javascript"></script>
<script src="<?php echo get_theme_url('js/doctor_login.js')?>" type="text/javascript"></script>
<div class="index-container w1024 bc">
    <div class="doctor-form">
        <form id="d_register" name="d_register" method="post">
            <h1 class="f24 mt30 mb20 tc">医生注册</h1>
            <div class="prev-title f14 pl20 pr10 clearfix"><span class="fl">您的个人隐私信息均不会被公开，请尽量填写完所有内容，加快申请审核进度。</span><span class="fr mr30">所填信息都会有51天使平台认证</span></div>
            <div class="status-box p20 clearfix">

                <div class="fl">
                    <p class="mt10">
                        <label class="in_b">用&nbsp;&nbsp;户&nbsp;&nbsp;名</label>
                        <input type="text" name="user_name" id="user_name" class="input-02 ml10 mr10" />
                        <span id="checkuser_name"></span>
                    </p>
                    <p class="mt10">
                        <label class="in_b">手&nbsp;&nbsp;机&nbsp;&nbsp;号</label>
                        <input type="text" name="phone" id="phone" class="input-02 ml10 mr10" />
                        <span id="checkphone"></span>
                    </p>
    <!--                <p class="mt10"><label class="in_b mr10">&nbsp;</label>手机号码即登录用户名</p>-->
                    <p class="mt10">
                        <label class="in_b">验&nbsp;&nbsp;证&nbsp;&nbsp;码</label>
                        <input type="text" name="t_check_code" id="t_check_code" maxlength="6" class="input-02 ml10 mr10" />
                        <a href="javascript:;" class="button-01 mr20" ts="0" id="count_down">获取验证码</a>
                        <span id="checkt_check_code"></span>
                    </p>
                    <p class="mt10">
                        <label class="in_b">设置密码</label>
                        <input type="text" name="password" id="password" class="input-01 ml10 mr10" />
                        <span id="checkpassword"></span>
                    </p>
                    <p class="mt10">
                        <label class="in_b">确认密码</label>
                        <input type="text" name="confirm_password" id="confirm_password" class="input-01 ml10 mr10" />
                        <span id="checkconfirm_password"></span>
                    </p>
    <!--                <p class="mt10">-->
    <!--                    <label class="in_b">复诊码编号</label>-->
    <!--                    <input type="text" class="input-01 ml10 mr10" />-->
    <!--                </p>-->
                    <p class="mt10">
                        <label class="in_b mr10">&nbsp;</label>
                        <input type="checkbox" id="d_agreement_flg"  name='d_agreement_flg' class="mr5" />我已阅读xxxx协议
                        <span id="checkd_agreement_flg"></span>
                    </p>
                </div>
                <div class="reg-right fr">
                    <img src="<?php echo get_theme_url('images/img/register-pic.jpg')?>" alt="" width="176" height="106" />
                    <p>我们提供的在线风湿免疫类健康咨询服务</p>
                    <p>95%用户表示满意</p>
                    <p>500名认证三甲医院风湿免疫医生</p>
                </div>
            </div>
            <div class="mt20 tc">
                <input value="注册" type="submit" class="button-01 mr20">
                <input value="取消" type="reset" class="button-01 mr20">
            </div>
        </form>
    </div>
</div>

